Provider Demographics
NPI:1598818312
Name:BUKOWSKI, COLETTE A (LPCC)
Entity Type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:A
Last Name:BUKOWSKI
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 SUNVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2843
Mailing Address - Country:US
Mailing Address - Phone:440-473-0230
Mailing Address - Fax:
Practice Address - Street 1:34900 CHARDON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9161
Practice Address - Country:US
Practice Address - Phone:216-548-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE4173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional